| 1. |
- da Silva, Cristina, et al.
(author)
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Hemodynamic outcomes of transcatheter aortic valve implantation with the CoreValve system : an early assessment
- 2015
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 35:3, s. 216-222
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Journal article (peer-reviewed)abstract
- Background and Aims: Transcatheter aortic valve implantation (TAVI) is an established method for the treatment of high-risk patients with aortic stenosis (AS). The beneficial effects of TAVI in cardiac hemodynamics have been described in recent studies, but those investigations were mostly performed after an interval of more than 6 months following aortic valve implantation. The aim of this study is to investigate the acute and short-term alterations in hemodynamic conditions using the echocardiography outcomes in patients undergoing TAVI. Methods and Results: A total of 60 patients (26 males, 34 females; age 84·7 ± 5·8) who underwent TAVI with CoreValve system were included in the study. Echocardiography was performed before hospital discharge and at 3 months follow-up. As expected, TAVI was associated with an immediate significant improvement in aortic valve area (AVA) (from 0·64 ± 0·16 cm2 to 1·67 ± 0·41 cm2, P-value<0·001) and mean gradient (from 51·9 ± 15·4 mmHg to 8·8 ± 3·8 mmHg, P-value<0·001). At 3-month follow-up, systolic LV function was augmented (EF: 50 ± 14% to 54 ± 11%, P-value = 0·024). Left ventricle (LV) mass and left atrium (LA) volume were significantly reduced (LV mass index from 126·5 ± 30·5 g m-2 to 102·4 ± 32·4 g m-2; LA index from 42·9 ± 17·3 ml m-2 to 33·6 ± 10·6 ml m-2; P-value<0·001 for both). Furthermore, a decrement in systolic pulmonary artery pressure (SPAP) from 47·5 ± 13·5 mmHg to 42·5 ± 11·2 mmHg, P-value = 0·02 was also observed. Despite the high incidence of paravalvular regurgitation (PVR) (80%), most of the patients presented mild or trace PVR and no significant progress of the regurgitation grade was seen after 3 months. Conclusion: This study demonstrates that the beneficial effects of TAVI in cardiac function and hemodynamics occur already after a short period following aortic valve implantation.
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| 2. |
- da Silva, Cristina, et al.
(author)
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Prosthesis-patient mismatch after transcatheter aortic valve implantation : impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography
- 2014
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In: The International Journal of Cardiovascular Imaging. - : Springer Science and Business Media LLC. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 30:8, s. 1549-1557
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Journal article (peer-reviewed)abstract
- To investigate the role of 2D-transthoracic echocardiography (2D-TTE) and 3D-transesophageal echocardiography (3D-TEE) in the determination of aortic annulus size prior transcatheter aortic valve implantation (TAVI) and its' impact on the prevalence of patient prosthesis mismatch (PPM). Echocardiography plays an important role in measuring aortic annulus dimension in patients undergoing TAVI. This has great importance since it determines both eligibility for TAVI and selection of prosthesis type and size, and can be potentially important in preventing an inadequate ratio between the prosthetic valvular orifice and the patient's body surface area, concept known as prosthesis-patient mismatch (PPM). A total of 45 patients were studied pre-TAVI: 20 underwent 3D-TEE (men/women 12/8, age 84.8 +/- A 5.6) and 25 2D-TTE (men/women 9/16, age 84.4 +/- A 5.4) in order to measure aortic annulus diameter. The presence of PPM was assessed before hospital discharge and after a mean period of 3 months. Moderate PPM was defined as indexed aortic valve area (AVAi) a parts per thousand currency sign 0.85 cm(2)/m(2) and severe PPM as AVAi < 0.65 cm(2)/m(2). Immediately post-TAVI, moderate PPM was present in 25 and 28 % of patients worked up using 3D-TEE and 2D-TTE respectively p value = n.s) and severe PPM occurred in 10 % of the patients who underwent 3D-TEE and in 20 % in those with 2D-TTE (p value = n.s). The echocardiographic evaluation 3 months post-TAVI showed 25 % moderate PPM in the 3D-TEE group compared with 24 % in the 2D-TTE group (p value = n.s) and no cases of severe PPM in the 3DTEE group comparing to 20 % in the 2D-TTE group (p = 0.032). Our results indicate a higher incidence of severe PPM in patients who performed 2DTTE compared to those performing 3DTEE prior TAVI. This suggests that the 3D technique should replace the 2DTTE analysis when investigating the aortic annulus diameter in patients undergoing TAVI.
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| 3. |
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| 4. |
- Bjursten, Henrik, et al.
(author)
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Characteristics and Outcomes of Patients Receiving a Second Rescue Valve During Transcatheter Aortic Valve Implantation
- 2024
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In: Structural Heart. - : Elsevier. - 2474-8706 .- 2474-8714. ; 8:2
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Journal article (peer-reviewed)abstract
- Background: Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry. Methods: The Swedish national TAVI registry was used as the primary data source, where all 6706 TAVI procedures from 2016 to 2021 were retrieved. Nontransfemoral access and planned valve-in-valve were excluded. In total, 79 patients were identified as having had a rescue-AV, and additional detailed data were collected for these patients. This dataset was analyzed for any characteristics that could predispose patients to a rescue-AV. The outcome of patients receiving rescue-AV also was studied. Results: Of the 5948 patients in the study, 1.3% had a rescue-AV. There were few differences between patients receiving 1 valve and rescue-AV patients. For patients receiving a rescue-AV, the 30-day mortality was 15.2% compared to 1.6% in the control group. A poor outcome after rescue-AV was often associated with a second complication; for example, stroke, need for emergency surgery, or heart failure. Among the patients with rescue-AV who survived at least 30 days, landmark analyses showed similar survival rates compared to the control group. Conclusions: Among TAVI patients in a nationwide register, rescue-AV occurred in 1.3% of patients. The 30-day mortality in patients receiving rescue-AV was high, but long-term outcome among 30-day survivors was similar to the control group.
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| 5. |
- Louca, Antros, 1989, et al.
(author)
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Coronary angiography following transcatheter aortic valve replacement : insights from the SWEDEHEART registry
- 2024
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In: Catheterization and cardiovascular interventions. - : John Wiley & Sons. - 1522-1946 .- 1522-726X.
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Journal article (peer-reviewed)abstract
- Background: Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance.Objectives: This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation.Methods: All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs.Results: Out of 9806 patients, 566 subsequently required coronary angiography. The incidence was highest for three-vessel and/or left main disease. Younger age, the extent of prior coronary artery disease, and peripheral vascular disease were associated with an increased risk of coronary angiography. Fluoroscopy time was increased in TAVR patients compared to the control group with the longest fluoroscopy times observed in cases involving supra-annular and self-expanding valves.Conclusions: The incidence of coronary angiography following TAVR is still low. Younger patients and patients with concomitant coronary artery disease have a higher risk. Procedural time is longer in patients with a previous THV replacement. As TAVR is emerging as the first-line treatment in patients with longer life expectancy, facilitating coronary access is an important factor when considering which THV device to implant.
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| 6. |
- Nielsen-Kudsk, Jens Erik, et al.
(author)
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Left atrial appendage occlusion versus standard medical care in patients with atrial fibrillation and intracerebral haemorrhage : a propensity score-matched follow-up study
- 2017
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In: EuroIntervention. - : EUROPA EDITION. - 1774-024X .- 1969-6213. ; 13:3, s. 371-378
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Journal article (peer-reviewed)abstract
- Aims: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. Methods and results: A total of 151 patients from the Nordic countries with AF and previous ICH who underwent LAAO using the AMPLATZER Cardiac Plug or the AMPLATZER AMULET were compared to a propensity score-matched group of 151 patients receiving standard medical therapy. The two groups were matched so that their risks for stroke and bleeding were similar (CHA2DS2-VASc and HAS-BLED scores). The standard care patients were identified from the Danish Stroke Registry among 787 patients with AF and ICH. The primary endpoint was a composite of all-cause mortality, ischaemic stroke and major bleeding. Patients with AF and a prior ICH treated with LAAO had a lower risk of the composite outcome as compared to patients treated with standard medical care (events/1,000 years [95% confidence interval]: 53.3 [44.3-64.1] vs. 366.7 [298.2-450.9]; hazard ratio 0.16 [0.07-0.37]). Conclusions: LAAO is suggested to be of major clinical benefit in AF patients having sustained an ICH. These results have to be confirmed in a randomised clinical trial.
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| 7. |
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| 8. |
- Nilsson, Konrad, et al.
(author)
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Regional assessment of availability for transcatheter aortic valve implantation in Sweden : a long-term observational study
- 2023
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In: European Heart Journal - Quality of Care and Clinical Outcomes. - : Oxford University Press. - 2058-5225 .- 2058-1742.
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Journal article (peer-reviewed)abstract
- BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an increasingly important treatment option for patients with severe aortic stenosis. Its best implementation is debated, as few centres with high volumes are associated with better outcomes, while centralisation might lead to an inferior availability of treatment for patients living far away. The aim of this study was to investigate the implementation of TAVI in Sweden with a focus on regional differences in terms of availability, short-term mortality and waiting times.METHODS: All patients undergoing TAVI between 2008 and 2020 from the Swedish Transcatheter Cardiac Intervention Registry (SWENTRY) were included. SWENTRY was linked to the National Cause of Death Registry and to publicly available geospatial data from Statistics Sweden.RESULTS: A total of 7280 patients were included. Over time, TAVI interventions increased markedly, while surgical aortic valve replacement (SAVR) remained constant. There were no statistically significant regional differences in incidence between counties with or without a local TAVI centre (p = 0.7) and no clustering tendencies around regions with a local TAVI centre (p = 0.99). Thirty-day mortality improved over time without evidence of regional differences. No regional differences in waiting time from decision to intervention were found for TAVI centre regions and non-TAVI centre regions (p = 0.7).CONCLUSION: This nationwide study indicated no regional differences in terms of availability, short-term mortality or waiting times. An organisation with a few specialised centres was found to be sufficient to provide national coverage of TAVI interventions.
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| 9. |
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| 10. |
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| 11. |
- Settergren, Magnus
(author)
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Endothelial dysfunction in patients with glucose abnormalities and coronary artery disease : studies of pathogenesis and treatment
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Background: Type 2 diabetes is associated with endothelial dysfunction, which is characterised by the reduced bioavailability of nitric oxide (NO). This is a result of increased oxidative stress and inflammation and the synthesis of endothelium-dependent vasoconstricting factors such as endothelin-1 (ET-1) caused by hyperglycaemia, insulin resistance and dyslipidemia. The dysfunction of the vascular endothelium is regarded as an important factor for the increased risk of cardiovascular disease seen in patients with type 2 diabetes and it is thought to play a major role in the pathogenesis of both micro- and macrovascular complications in this patient category. This thesis aims to further explore the pathogenesis and treatment options of endothelial dysfunction in patients with glucose abnormalities. Studies I-II: The importance of the lipid-independent (pleiotropic) effects of statins was studied in 43 patients with dysglycemia and coronary artery disease. Intensive lipid lowering with either 80 mg of simvastatin or a combination of 10 mg of simvastatin together with 10 mg of ezetimibe improved macrovascular endothelial function and microvascular function (n=36) and reduced inflammation. No difference between the two treatment strategies was found, indicating that the improvements were mainly due to lipid lowering and not to the pleiotropic effects of statins. Study III: The effect of endothelin-A-receptor blockade on nutritive skin capillary circulation in patients with type 2 diabetes and microangiopathy was studied. Intra-arterial infusions of an endothelin-A-receptor antagonist improved nutritive skin capillary circulation in patients with type 2 diabetes (n=10) but not in healthy controls (n=8). This finding suggests that ET-1 is involved in the pathogenesis of diabetic microangiopathy. Study IV: The effect of L-arginine and tetrahydrobiopterin (BH4) infusion on ischemia/reperfusion (I/R)-induced endothelial dysfunction following 20 minutes of forearm ischemia was studied in 12 patients with type 2 diabetes and coronary artery disease. L-arginine and BH4 significantly attenuated I/R-induced endothelial dysfunction in comparison with placebo. Conclusions: The present studies of patients with type 2 diabetes and vascular complications indicate that 1) lipid lowering is more important than the pleiotropic effects of statins for the improvement in macrovascular endothelial function and microvascular function and the reduction in inflammation; 2) targeting the ET-1 system might be of importance in the treatment of complications related to diabetic microangiopathy and 3) supplementation with L-arginine and BH4 may represent a future treatment strategy to limit the I/R injury in patients with type 2 diabetes.
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| 12. |
- Settergren, Magnus, et al.
(author)
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Mitralisklaffsjukdom: »Nu kan vi både öppna och stänga« : [Mitral valve disease:"Now we can both open and close"]
- 2011
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In: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 108:20, s. 1117-1122
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Journal article (peer-reviewed)abstract
- Mitralisinsufficiens är vanligt förekommande bland äldre. En betydande andel av patienterna lämpar sig inte för öppen kirurgi på grund av ökad operationsrisk. Det finns därför ett behov av ett mindre invasivt behandlingsalternativ för denna patientgrupp. För att behandla mitralisinsufficiens har ett flertal perkutana tekniker utvecklats med lovande initiala resultat och stor framtida klinisk potential. Mitralisstenos orsakas oftast av genomgången reumatisk feber. Symtomgivande mitralisstenos kan behandlas med kirurgi eller ballongdilatation. Mitralisstenosens patofysiologi och diagnostik presenteras, liksom olika metoder för bedömning av svårighetsgrad och val av behandling. Slutligen beskrivs det praktiska förfarandet vid mitralisvalvulotomi.
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| 13. |
- Snowden, Stuart G., et al.
(author)
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High-dose simvastatin exhibits enhanced lipid-lowering effects relative to simvastatin/ezetimibe combination therapy
- 2014
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In: Circulation. - : Lippincott Williams & Wilkins. - 1942-325X .- 1942-3268. ; 7:6, s. 955-964
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Journal article (peer-reviewed)abstract
- Statins are the frontline in cholesterol reduction therapies; however, their use in combination with agents that possess complimentary mechanisms of action may achieve further reductions in low-density lipoprotein cholesterol. Thirty-nine patients were treated with either 80 mg simvastatin (n=20) or 10 mg simvastatin plus 10 mg ezetimibe (n=19) for 6 weeks. Dosing was designed to produce comparable low-density lipoprotein cholesterol reductions, while enabling assessment of potential simvastatin-associated pleiotropic effects. Baseline and post-treatment plasma were analyzed for lipid mediators (eg, eicosanoids and endocannabinoids) and structural lipids by liquid chromatography tandem mass spectrometry. After statistical analysis and orthogonal projections to latent structures multivariate modeling, no changes were observed in lipid mediator levels, whereas global structural lipids were reduced in response to both monotherapy (R(2)Y=0.74; Q(2)=0.66; cross-validated ANOVA P=7.0×10(-8)) and combination therapy (R(2)Y=0.67; Q(2)=0.54; cross-validated ANOVA P=2.6×10(-5)). Orthogonal projections to latent structures modeling identified a subset of 12 lipids that classified the 2 treatment groups after 6 weeks (R(2)Y=0.65; Q(2)=0.61; cross-validated ANOVA P=5.4×10(-8)). Decreases in the lipid species phosphatidylcholine (15:0/18:2) and hexosyl-ceramide (d18:1/24:0) were the strongest discriminators of low-density lipoprotein cholesterol reductions for both treatment groups (q<0.00005), whereas phosphatidylethanolamine (36:3e) contributed most to distinguishing treatment groups (q=0.017). Shifts in lipid composition were similar for high-dose simvastatin and simvastatin/ezetimibe combination therapy, but the magnitude of the reduction was linked to simvastatin dosage. Simvastatin therapy did not affect circulating levels of lipid mediators, suggesting that pleiotropic effects are not associated with eicosanoid production. Only high-dose simvastatin reduced the relative proportion of sphingomyelin and ceramide to phosphatidylcholine (q=0.008), suggesting a pleiotropic effect previously associated with a reduced risk of cardiovascular disease.
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